Verifying the impact of corporate governance on hospital performance on HIV and malaria control: A structural equation modelling approach.

BACKGROUND: The research aims to study the impact of corporate governance on hospital performance regarding HIV and malaria control, using the Ghana health industry as a case. The nation is making frantic effort to control HIV and malaria, since they continue to be among the deadliest diseases that attract holistic attention; hence, there is the need to put structures in place to curb the spread. METHODS: A total of 1005 precoded questionnaires were administered to 125 hospitals, for responses from staff, managers, board, and chief executive officers (CEOs). The collated data were analysed using structural equation modelling approach. RESULTS: Our research revealed that corporate governance has a positive effect on hospital performance, regarding the control of the two deadly diseases (HIV and malaria). The interventions in Ghana health delivery have brought a level of improvement in malaria control, since the disease mortality has significantly declined from 19% in 2010 to 4% in 2016. Through the implementation of systems and policies, the national HIV prevalence has admirably reduced from 2.9% in 2000 to 1.6% in 2017. CONCLUSIONS: Hospitals are therefore encouraged to continue to implement effective corporate governance mechanisms to facilitate efficient, well-organised, and prudent practices that can deliver more institutional performance in HIV and malaria control.

Fascicular heart blocks and risk of adverse cardiovascular outcomes: Results from a large primary care population.

BACKGROUND: Fascicular heart blocks can progress to complete heart blocks, but this risk has not been evaluated in a large general population. OBJECTIVE: The purpose of this study was to investigate the association between various types of fascicular blocks diagnosed by electrocardiographic (ECG) readings and the risk of incident higher degree atrioventricular block (AVB), syncope, pacemaker implantation, and death. METHODS: We studied primary care patients referred for ECG recording between 2001 and 2015. Cox regression models were used to estimate hazard ratios (HRs) as well as absolute risks of cardiovascular outcomes. RESULTS: Of 358,958 primary care patients (median age 54 years; 55% women), 13,636 (3.8%) had any type of fascicular block. Patients were followed up to 15.9 years. We found increasing HRs of incident syncope, pacemaker implantation, and third-degree AVB with increasing complexity of fascicular block. Compared with no block, isolated left anterior fascicular block (LAFB) was associated with 0%-2% increased 10-year risk of developing third-degree AVB (HR 1.6; 95% confidence interval [CI] 1.25-2.05), whereas right bundle branch block combined with LAFB and first-degree AVB was associated with up to 23% increased 10-year risk (HR 11.0; 95% CI 7.7-15.7), depending on age and sex group. Except for left posterior fascicular block (HR 2.09; 95% CI 1.87-2.32), we did not find any relevant associations between fascicular block and death. CONCLUSION: We found that higher degrees of fascicular blocks were associated with increasing risk of syncope, pacemaker implantation, and complete heart block, but the association with death was negligible.

Investigation on key contributors of energy consumption in dynamic heterogeneous panel data (DHPD) model for African countries: fresh evidence from dynamic common correlated effect (DCCE) approach.

The main aim of this current study is to empirically scrutinize the determinants of energy consumption for 24 African countries sub-grouped into three panels based on income levels: low-, lower-middle-, and upper-middle-income countries, from 1990 to 2015. Due to the presence of heterogeneity and cross-sectional reliance among country groups, recently developed econometric approaches, which include cross-sectional Im, Pesaran, and Shin together with cross-sectional Augmented Dickey-Fuller stationarity tests, Pedroni and Westerlund-Edgerton cointegration assessment, dynamic common correlated effect estimation approach and Dumitrescu-Hurlin Granger causality test are employed. Empirically, our findings depict analyzed variables are stationary and characterized by long-term stability affiliations for all panels. Economic growth, urbanization, population growth, and oil price with labor and capital stock as intermittent variables had palpable significant positive sway on energy consumption for all panels though their respective weight of contribution differed from one country group to another. The granger test of causation unveiled that (i) among all panels, urbanization and energy consumption are connected bidirectionally, whereas population growth causes energy consumption; (ii) a one-way causal link from economic growth to energy use is evidenced in low-income African countries, whereas a two-sided connection is confirmed in both lower-middle- and upper-middle-income economies; (iii) a bilateral causal association in low-income African nations is observed amid oil price and energy use, while a uni-lateral relationship extends from oil price to energy consumption in both lower-middle- and upper-middle-income nations in Africa. Such new methodologies and findings reveal that the long-term estimated effects as well as causal affiliations amid variables are skewed by different income levels of African countries in an attempt to conserve energy. Policy recommendations are further propose.

Antibody blockade of the Cripto CFC domain suppresses tumor cell growth in vivo.

Cripto, a cell surface-associated protein belonging to the EGF-CFC family of growth factor-like molecules, is overexpressed in many human solid tumors, including 70-80% of breast and colon tumors, yet how it promotes cell transformation is unclear. During embryogenesis, Cripto complexes with Alk4 via its unique cysteine-rich CFC domain to facilitate signaling by the TGF-beta ligand Nodal. We report, for the first time to our knowledge, that Cripto can directly bind to another TGF-beta ligand, Activin B, and that Cripto overexpression blocks Activin B growth inhibition of breast cancer cells. This result suggests a novel mechanism for antagonizing Activin signaling that could promote tumorigenesis by deregulating growth homeostasis. We show that an anti-CFC domain antibody, A8.G3.5, both disrupts Cripto-Nodal signaling and reverses Cripto blockade of Activin B-induced growth suppression by blocking Cripto's association with either Alk4 or Activin B. In two xenograft models, testicular and colon cancer, A8.G3.5 inhibited tumor cell growth by up to 70%. Both Nodal and Activin B expression was found in the xenograft tumor, suggesting that either ligand could be promoting tumorigenesis. These data validate that functional blockade of Cripto inhibits tumor growth and highlight antibodies that block Cripto signaling mediated through its CFC domain as an important class of antibodies for further therapeutic development.

Successful tolerance induction under CD40 ligation in a rodent small bowel transplant model: first report of a study with the novel antibody AH.F5.

BACKGROUND: Intestinal transplantation has been hampered by high rates of intestinal allograft rejection. One mechanism of altering rejection in other organ transplant models has been blockade of second set T-cell costimulatory signals. AH.F5, a novel hamster anti-rat monoclonal antibody to CD154, blocks CD40-dependent T-cell costimulation. We hypothesized that blockade of this pathway might abrogate rejection in a rodent orthotopic survival model of intestinal transplantation. METHODS: Eight groups were studied with different dosing schema, including syngeneic transplants (group 1), untreated allogeneic transplants (group 2), allogeneic transplants plus multiple doses of AH.F5 alone given IV or s.c. (groups 3 and 4), allogeneic transplants plus donor splenocyte preconditioning with and without single dose AH.F5 (groups 5 and 6), and donor splenocyte preconditioning followed by multiple doses of AH.F5 with and without thymectomy (groups 7 and 8). RESULTS: Control animals all died within 12 days of transplantation, whereas antibody-alone and splenocytes-alone resulted in modest prolongation of survival to 16 days. Only animals treated with splenocytes before transplantation and AH.F5 survived long-term (>60 days, group 8). These animals tolerated donor-specific skin grafts, rejected third-party grafts, and fed normally. However, their weight gain was subnormal and they demonstrated intestinal muscular thickening, which might represent chronic rejection. Thymectomy prevented the induction of tolerance. CONCLUSIONS: AH.F5 prevents acute intestinal allograft rejection in combination with donor-specific splenocyte preconditioning. We achieved long-term survival and the animals appeared tolerant. Central conditioning is essential for success with this antibody when used alone. Further studies with different dosing regimens or second agents seem warranted.

Grammar tests increase the ability to lateralize language function in the Wada test.

INTRODUCTION: Grammar is a core component of the language system, yet it is rarely assessed during the Wada (intracarotid amobarbital) test. It is hypothesized that adding grammar tests to the recovery phase of the Wada test will increase our ability to lateralize language function. METHOD: Sixteen individuals (nine females, fifteen right-handed, mean age 38.4 years, SD=10.7) with medically refractory temporal lobe epilepsy participated in the study. On EEG ten patients had seizures originating in the left hemisphere (LH), five in the right hemisphere (RH), and one was insufficiently lateralized. We included only patients who were LH-dominant on the standard test in the encoding phase of the Wada test. In the recovery phase of Wada testing the participants underwent evaluation with a standard language and a new test of grammar, the CYCLE-N. Ten patients underwent bilateral injections, six unilateral (one RH, five LH). RESULTS: As expected, injection in the LH decreased language performance to a greater extent than injection to the RH on both tests. However, the CYCLE-N produced more profound language deficits in the injected LH compared to the RH (p=0.01), whereas the standard tests did not cause such pronounced differences (p=0.2). CONCLUSION: The results suggest that the standard tests did not significantly differentiate the effects of the injections and the CYCLE-N, for the most part, did. Our results are of particular relevance to patients who are too obtunded to speak in the encoding phase. In sum, the CYCLE-N may be helpful in assessing hemispheric dominance for language.

Comparison of soluble decoy IgG fusion proteins of BAFF-R and BCMA as antagonists for BAFF.

BAFF is considered a therapeutic target because dysregulated production of BAFF can induce systemic lupus erythematosus-like phenotype in mice, and elevated levels of BAFF are associated with disease severity in systemic lupus erythematosus and rheumatoid arthritis patients. Fc fusion decoy receptors, BCMA-Fc and BAFF-R-Fc, are therapeutic candidates for blocking BAFF. While studying their interactions with BAFF, we found that BAFF-R-Fc is more effective than BCMA-Fc for blocking BAFF binding to its receptors. We also found that a trimeric BAFF can bind more than one BAFF-R-Fc but only one BCMA-Fc. Moreover, we show that, in contrast to monovalent BAFF-R-Fc, monovalent BCMA does not form stable complexes with BAFF. Differences in their interaction with BAFF predict BAFF-R-Fc would be a better inhibitor. Indeed, we show BAFF-R-Fc is 10-fold more efficacious than BCMA-Fc for blocking BAFF-induced B cell proliferation in vitro and for blocking BAFF-mediated survival of mouse splenic B lymphocytes in vivo.